On April 6, Department of Veterans Affairs (VA) Secretary Denis McDonough testified on the administration's budget request for fiscal year (FY) 2023, with a focus on the VA’s health care priorities [refer to Washington Highlights, April 1].
In his opening statement before the House Military Construction, VA, and Related Agencies Appropriations Subcommittee, McDonough stated that the proposed budget will “help us save lives by investing nearly $1 billion in VA's groundbreaking research, including long COVID and cancer research.” Subcommittee Chair Debbie Wasserman Schultz (D-Fla.) highlighted the research program in her opening statement as one that subcommittee members are “extremely interested in.”
Wasserman Schultz asked McDonough specifically about the department’s need for continued increasing costs of health care provided by the VA, both in-house and through the Community Care Network (CCN) established in the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSON) Act (P.L. 115-182). “What's the long-term plan here? I mean, clearly we must provide for our veterans' health care. … But if we're going to keep seeing these exponential increases year after year, we need to build a consensus on an allocation adjustment so that other discretionary priorities are not affected,” she said.
The president’s budget proposes that the $119 billion requested for VA medical care accounts be established as its own discretionary spending category, outside of the traditional defense and non-defense categories, to address the rising costs. Chairs and ranking members of the House and Senate Appropriations Committees have indicated a plan to meet in the coming weeks to discuss topline spending for FY 2023 and are expected to face difficult negotiations on the administration’s request for separate funding for VA medical care.
Wasserman Schultz and Ranking Member John Carter (R-Texas) raised skepticism about the rationale for the newly proposed funding mechanism despite support for the VA’s role as a health care provider and coordinator of care for more than 9 million veterans. McDonough argued that VA health care spending “at the expense of the rest of the non-defense discretionary makes [VA] less effective overall,” and praised the Office of Management and Budget for its innovative budget request. McDonough added that a legislative proposal for the budget mechanism would be forthcoming.
He added that the larger increase in the medical care request is a reflection of the cost of inflation as well as increasing demand by veterans for more complex care and the need to maintain investments made throughout the pandemic, including facility modernization. He added that the VA is increasingly paying for care provided in the community through the CCN, which is being utilized at a higher rate than estimated by the administration when the MISSION Act was passed in 2018.
Rep. Susie Lee (D-Nev.) asked about the recently released recommendations for the Assets and Infrastructure Review (AIR) Commission intended to modernize VA health care infrastructure [refer to Washington Highlights, March 18], noting concern about the department’s recommendation to close VA facilities in her district. McDonough noted that the data that informed the recommendations was collected before the COVID-19 pandemic, but that the VA would continue to update the data as the commission undertakes its review of the recommendations.
“The whole set of recommendations are designed to try to get more care in a more updated fashion and more modern facilities closer to our veterans,” McDonough reminded the subcommittee. “These are my recommendations to the President. The President gets to take a fresh look at these after hearing from you and the commission and others about whether to proceed with them or not.”
The budget request includes a $5 million request to support the AIR Commission’s work to review the department’s recommendations over the next fiscal year.